Socialized Medicine

[LoBlo]

Who here is from a country with a socialized medicine program?

I'm curious about what people that live in socialized medicine programs feel about their program, how their programs work, and whether or not they feel things are managed optimally by their government, whether they are satisfied, or if not, what grievances exist.

Here are some specific questions that I'm curious about

1. How does your system work? Anything special about getting seen in a clinic, or do you just make an appointment, show up and that's it free service?
2. Are wait times for doctors visits short or too long?
3. Are diagnostic test readily available or do they take many months of waiting list? Is access to routine care and clinics as easy as life threatening and care for significantly morbid conditions (liver failure, heart failure)?
4. Do you thrust your doctors?
5. Are they all equal in your eyes are or some doctors/hospitals better than others? If so, do you get to choose the doctor/clinic/hospital that you wish to go to, or are you forced to see a certain doctor/etc by the program?

I'm especially interested in how the Canadian system works since they are a relatively large country with a large system in place. (Things that work for smaller countries might not neccessarily work countries many times largers or which more heterogenous populations).

Opionions?

[Skybird]

System worked well in Germany - until the last years. It now is being hollowed out by to powerful lobbies for pharmaceutcial industry, pharmacists (both leading to very high prices for medicine), doctors. The growing costs (which now are at very high levels) have caused a slow death to the system, and due to lobbying and lacking competition it has become too expensive, which led to an effectice two-class-medicine program now. Currewntly we need to pay more and more for less and lesser services being covered by our insurances.

1. Not often I visit doctors. when I do, wait time is short.

2. Tests are being done quickly, but more and more even of vital ones are no longer covered by what insurances pay for.

3. Depends on the single man. I had good ones, and also bad ones.

4. Some hospitals are better than others. If you are with a private insurance you have better chances to have a word in which hospital you go to, which doctor will treat you, and if your room is crowded, or a single one. Normally you get send to the closest or most central one, if your house doctor arranges it. Private insurance comes at the cost of the insurance rate being raised more often. It is permitted by law to get yourself a private insurancer as long as your monthly income does not reach a certain and relatively high level. This is meant to prevent that the other insurances are left with only the poor people that pay low sums to them only.the system is more and more seriuously deformated and it is clear that it must be drastically changed, it's a major project in politics. However, both parties are effectively neutralzing each other, and the compromise is a very bad and half-hearted one, whcih additionally is put into question and is under heavy fire by more and more politicians. Lobbys are still having too much to say in it. Result: attempts of fixing the insurance rates get broken time and again, people pay more and more over the years, and service becomes worse.

One should say that as hospital doctor you are screwed. The payment is unacceptable, and (most important) working shifts can be close to 40 hours. Want to undego surgery in a life-threatening service by someone who hasn'T slept for 30 hours and is exhausted by load of work and stress? Happens here, every day, in every hospital. We currently have a growing emigration movement of highly qualified young doctors and beginners to other european countries, while especially in the East of Germany more and more areas and regions do not have a sufficient medical supply with hopuse doctors. That is a catastrophe especially for the old and ill ones.

[Perilscope]

1. How does your system work? Anything special about getting seen in a clinic, or do you just make an appointment, show up and that's it free service?
Here in Canada, at birth you get a Medicare card, you present that card whatever you go, as long it's not private, like dentist, chiropractic and other specialized services, it's free. Well, free, it’s a way of saying it, money comes from the mass, you know what I mean.

2. Are wait times for doctors visits short or too long?
I do not know elsewhere in Canada, but here in Quebec we are notorious for having the longest wait time if you go to emergencies (Hospital), at local family doctors (Clinic), it's faster.

3. Are diagnostic test readily available or do they take many months of waiting list? Is access to routine care and clinics as easy as life threatening and care for significantly morbid conditions (liver failure, heart failure)?
Depending on your case, you may wait months, like you may get prioritized, it all depends on the seriousness of you illness.

4. Do you thrust your doctors?
We have very good doctors, but then again, like everywhere else, you might get the occasional idiot.


5. Are they all equal in your eyes are or some doctors/hospitals better than others? If so, do you get to choose the doctor/clinic/hospital that you wish to go to, or are you forced to see a certain doctor/etc by the program?
We pretty much choose where we want to go, at first, then you have to follow directions, if one Hospital specializes in a certain illness, well, you have no choice but to go there. As for equality, no, different people administer them, so in some place you will feel that things are better, but in general it's all okay.

Canada in general is very good, and the world appraises us in general. :yep:

[scandium]

Who here is from a country with a socialized medicine program?

I'm curious about what people that live in socialized medicine programs feel about their program, how their programs work, and whether or not they feel things are managed optimally by their government, whether they are satisfied, or if not, what grievances exist.

Here are some specific questions that I'm curious about

1. How does your system work? Anything special about getting seen in a clinic, or do you just make an appointment, show up and that's it free service?
2. Are wait times for doctors visits short or too long?
3. Are diagnostic test readily available or do they take many months of waiting list? Is access to routine care and clinics as easy as life threatening and care for significantly morbid conditions (liver failure, heart failure)?
4. Do you thrust your doctors?
5. Are they all equal in your eyes are or some doctors/hospitals better than others? If so, do you get to choose the doctor/clinic/hospital that you wish to go to, or are you forced to see a certain doctor/etc by the program?

I'm especially interested in how the Canadian system works since they are a relatively large country with a large system in place. (Things that work for smaller countries might not neccessarily work countries many times largers or which more heterogenous populations).

Opionions?

Another Canadian perspective (one from a different province), though my answers are very similar to Perilscope's:

1. Our system is "single tier" in that all Canadians, from birth, have medicare access to essential health services; generally that is anything hospital or clinic related, but you pay (either through additional private insurance or out of pocket) for things like prescriptions (except those administered as a hospital inpatient), eye glasses, dental (though here, and probably elsewhere it is covered by medicare, to a point, for children upto a certain age), private physiotherapy, massage therapy, and cosmetic surgery (except where needed to fix damage from either birth defect or injury, ie skin grafts etc). The actual delivery of service is done through both public and private hospitals and clinics (medicare generally only concerns itself with the service itself, and not with how its delivered)

2. Wait times vary from region to region and even province to province. For clinics it is usually not long, and some will accept walk in appointments. Otherwise, for hospital visits and procedures it will vary depending on the seriousness of the injury/illness. Generally speaking when you go to an ER you are seen right away by a triage nurse who checks your vitals and asks you a series of questions to try and assess the seriousness of the injury/illness and that will then determine how long you wait.... if it something like, for instance, a fractured bone you could be waiting hours, but for something that might presents with symptoms of what could be a more serious illness (say appendicitis) you would be seen immediately. It is the same for specialists and surgeries/hospital procedures... if it can wait, then you're going to wait. If its urgent or life threatening then you are moved to the top of the list and rarely will you wait.

3. Same as above.

4. I've had doctors I didn't trust and doctors that I've trusted absolutely; that is hit or miss, like any other profession, but you are free to choose your own doctor so if you don't like or trust them then you can pick another. I went through a few doctors here, good and bad, before I wound up with a regular family doctor that I now see exclusively and trust completely. Probably my worst experience there was when being treated in the ER for a wisdom tooth infection that was misdiagnosed and initially treated as a migraine; I'm one of those unfortunate few who get regular migraines that are, rarely, so severe that I have to go to the ER (because the nausea is so bad that I can't keep any pain killers or anti-nauseants down and it is combined with very intense pain and frequent vomitting and dry heaves leading to dehydration and worsening symptoms)... that particular visit I knew it wasn't a migraine because I had no light or sound sensitivity, no nausea, and the pain was on the wrong side of my head and not the same kind of pain as a migraine... I'd thought it an ear infection but after looking in my ears the doc said no, insisted it was a migraine (despite my explanation of why it wasn't) and insisted on treating me as though it were one anyway... outcome: several wasted hours in the emergency room waiting for migraine meds to "work" that of course didn't before it was properly diagnosed and treated, and by then I was so doped up by the meds (I could barely walk) and it was so late that it cost me a day of work that it wouldn't have if the doctor had listened and properly diagnosed it instead of wasting hours treating something I didn't have.

5. See above, but no they are not all equal, but at least you get to choose (except when you are admitted to a hospital via ambulance or when you have to have a certain kind of treatment that can only be performed at one hospital).

[TteFAboB]

I'll take it you mean a country where a public service exists because truly socialized medicine (understanding as the complete absence of a private sector) can only be found in 2nd world (and former) countries. Personally I've only known for long the Italian and Brazilian systems.

1. How does your system work? Anything special about getting seen in a clinic, or do you just make an appointment, show up and that's it free service?

It doesn't. Just kidding. The Italian system is in decay, has recently had to drop subsidies on medications and has murdered or permanently damaged more people than the Brazilian so I'll focus on the latter (speaking of the former will put me in hospital).

Make an appointment or show up and that's it. As Mr. P says free is a way of saying it because the money comes from the mass. Obviously not every treatment, surgery or medication is covered or instantly available. Some things are only partially subsidized. Some are not available at all.

2. Are wait times for doctors visits short or too long?

Depends entirely on the hospital and treatment at hand. Some hospitals and clinics are more cluttered than others and have longer waiting lines. Some surgeries have longer waiting lines than others. There's everything from minutes or hours to days to weeks to months of waiting.

3. Are diagnostic test readily available or do they take many months of waiting list? Is access to routine care and clinics as easy as life threatening and care for significantly morbid conditions (liver failure, heart failure)?


Again it depends. Basic diagnostic tests will have shorter waiting times than complex procedures in general but some hospitals or clinics may take longer than others. The second question depends too (getting repetitive?). In general the higher the demand for "routine care" in contrast with a static, possibly insufficient public supply the more difficult access becomes. Care to morbid conditions will depend on the amount of patients at the hospital, if the emergency is cluttered the treatment might suffer some delay unless death is imminent. They'll take you in anyway in death cases, even if there's only room for you at the corridors.

4. Do you thrust your doctors?


No, I slash them. Just kidding. No, I put more trust on veterinarians. I'm kidding again. It's the "D" word again. The good hospitals I'd trust though there's only a few of them country-wide (in Italy it doesn't matter since travel is quick). The more "professional" hospitals have good staff while the smaller, secluded or unprestigious ones have death and medical error written all over them. The doctor is only there because he accepted to participate in whatever corruption scheme is running and it doesn't really matter if his performance is acceptable or terrible.

5. Are they all equal in your eyes are or some doctors/hospitals better than others? If so, do you get to choose the doctor/clinic/hospital that you wish to go to, or are you forced to see a certain doctor/etc by the program?


Damn why didn't you asked this before? :rotfl:
If you've read me so far I guess it's not necessary to answer the first question. But it depends on availability. In general you are "forced" to go where they find a spot for you or where the treatment is available, the cost of the trip may be covered or not.

You cannot maintain a wide network of public hospitals in a large country unless you raise taxes to the roof and make healthcare your ratio essendi, if you will, the purpose all citizens live for. You have a few excellent public hospitals but those come at the cost of a worse network which cannot match the market. Balancing quality versus quantity and making sure there is enough money left to subsidize enough private clinics has proven difficult but where successful acceptable. Specialized hospitals find a good source of income to depend less on taxes by offering their special services to insurance companies. In return this cycle allows the state to actually provide the same insurance to those who can't afford it increasing competition among hospitals to break the monopoly within the public system which can then compete with the private system.

The system is very good in theory and where it works far better than Italy's, which is quite an accomplishment indeed. It just needs to be wiped clean of corruption and managed by professionals who can manage a hospital to organize and execute a budget efficiently and reduce waste to a minimum, even if that means asking for volunteers or handing the control to a decent medical university free of ideology as happens occasionally when the incompetent public employees fail their job or prove uncapable or unwilling to reduce waste. The future could be very bright.

[XabbaRus]

UK is pretty similar to Canada. People bitch and moan about the NHS but I haven't had a problem with it. Free at point of access but of course you pay for it in your taxes. I'd prefer that than having to write out a cheque or pay for it and then get it reimbursed like in some countries.

Wait times depend on area, previous clicn you could get a next day or sometimes same day appointment with your GP of choice but new clinic you can wait a few days unless you aren't fussy. I don't think that is the systems fault just my local clinic.

For minor stuff test are done quickly and up in NE Scotland even for bigger stuff results come back quickly. Government are trying to privatise by stealth obsessed by targets which can't be met.

Problem in the UK is that although expenditure has gone up it seems to be spent more on extra managers than doctors. For every patient in the UK there is one admin member of staff.

Apart from that it works as well as in any other country that has social medicine. Better in some areas worse than in others.

[Perilscope]

I'd prefer that than having to write out a cheque or pay for it and then get it reimbursed like in some countries.
You want to hear a story of cheque writing.

Here it is:
When my wife's cousin living in the USA needed to give birth, she made the biggest mistake to not be insured, you know what, she received a nice receipt of over 22,000$US for hospital fees.
Talk about nice souvenir for bringing a new born to life. Ten years later, she is still writing cheque to pay off that debt.

On the other hand, my wife when she gave birth here in Canada, we barely paid 300$CA, and you know what, if we even paid that, its only because we decided that my wife would be better off in a private room rather than the normal room, which is free all the way. :yep:

[zeropoint]

1. How does your system work? Anything special about getting seen in a clinic, or do you just make an appointment, show up and that's it free service?

I'm Canadian and it's been covered.

2. Are wait times for doctors visits short or too long?

Depends on where you go. Some places are better than others. I have lived in Manitoba but I now live in Quebec and it's much worse here in comparison.

3. Are diagnostic test readily available or do they take many months of waiting list? Is access to routine care and clinics as easy as life threatening and care for significantly morbid conditions (liver failure, heart failure)?

Again, it depends on where you live. Although private diagnostics are becoming more available.

4. Do you thrust your doctors?

For surgical procedures, absolutly. For the diagnosis if illnesses and the prescription of medications, not even a little. Same problem as American doctors: too much influance from pharmaceutical industries.

5. Are they all equal in your eyes are or some doctors/hospitals better than others? If so, do you get to choose the doctor/clinic/hospital that you wish to go to, or are you forced to see a certain doctor/etc by the program?

You can choose where to go and some places are better than others. For example, if you ever find yourself in Winnipeg and in need of medical care, seek out the Hospital St. Boniface. If you are in Montreal, avoid the Royal Victoria Hospital at all costs.

Personally, I am all for two tier health care. I would rather have a private system here in Canada tempting OUR doctors away from the public system than having them leave the country with thier expertise and tax dollars.